AIDS and IgA Nephropathy

Sabine Kenouch, MD, Department of Nephrology, Hôpital Bichat, 46, rue Henri Huchard, F-75018 Paris (France) Sir, We read with interest the letter of Béné et al. [1]. Based upon the absence of 1⁄8A deposits in all but one autopsy specimens of kidney from 54 AIDS patients the authors express the opinion that the presence of IgA mesan-gial deposits in the 2 patients with AIDS-re-lated complex we reported in 1990 [2] was purely coincidental. In their opinion, these patients were suffering from IgA nephropathy (IgAN) not related to HIV infection. Though the occurrence of two unrelated diseases cannot be excluded, we would like to stress that since our paper was published we have observed 1 additional case of IgAN in a patient with overt AIDS. Five other cases have been published. 4 by Bargman et al. [3] and 1 by Jindal et al. [4]. In addition to the similarities of abnormalities of the IgA immune system found in HIVinfected patients and in those with IgAN [5, 6], Warmold et al. [7] found higher levels of binding to matrix components of normal human kidney of serum IgA both from patients with IgA nephropathy and AIDS than from normal controls. It must also be stressed that HIV-infected patients with IgAN were all Caucasian [Bargman, personal commun. for her patients], a finding in keeping with the rarity of primary IgAN in blacks. In this respect, one would like to know what was the ethnic origin of the patients of Béné et al. [1]. Referring to the absence of IgA mesangial deposits in the patients of Jackson et al. [6], one might assume that the majority of them were black since the authors are from Alabama. In conclusion, though a coincidence cannot be definitely excluded, we think that Caucasian HIV-infected patients are at a higher risk for mesangial IgA deposition. References Béné, M.-C; Canton, P.; Amid, C; May, T.; Faure, G.: Absence of mesangial IgA in AIDS: A postmortem study. Nephron 58: 240-241 (1991). Kenouch, S.; Delahousse, M.; Méry, J.Ph.; Nochy, D.: Mesangial IgA deposits in two patients with AIDS-related complex. Nephron 54: 338-340 (1990). Bargman, J.M.; Katz, A.; Miller, D.C.; Guo J.J.W.; Schoeneman, M.J.; Ghai, V.S.: IgA nephritis in HIV positive patients. A new AIDS nephropathy (abstract). J. Am. Soc. Nephrol. 7: 304 (1990). Jindal, K.K.; Trillo, A.; Bishop, G.; Hirsch, D.; Cohen, A.: Crescentic IgA nephropathy as a manifestation of human immune deficiency virus infection. Am. J. Nephrol. 77:147-150 (1991). Procaccia, S.; Lazzarin, A.; Colucci, A.; Gaspar-ini, A.; Forcellini, P.; Lanzanova, D.; Uberti Foppa, C; Novati, R.; Zanussi, C: IgM, IgG and IgA rheumatoid factors and circulating immune complexes in patients with AIDS and AIDS-related complex with